Case management of ultra-processed food addiction: a theoretical perspective

Ultraprocessed food addiction (UPFA) is a complex and conceptually contested construct, uniting clinical and pathophysiological elements of eating disorders (EDs), behavioral addictions (BAs), substance use disorders (SUDs), and metabolic disorders (MDs). Despite increasing empirical interest, no formal diagnostic criteria or structured treatment recommendations currently exist. The case management of individuals presenting with UPFA raises important challenges for mental health specialists, as no therapeutic guidelines for this condition exist. This theoretical perspective proposes a stepped-care model, including psychotherapeutic, nutritional, and pharmacotherapeutic interventions, as well as lifestyle changes, based on a Research Domain Criteria (RDoC) framework. By mapping UPFA components onto positive and negative valence systems, cognitive control processes, social mechanisms, arousal regulation, and habit circuitry, the suggested model conceptualizes this addiction as a dimensional pattern of dysregulated reward processing, stress responsivity, impaired executive control, and automatized eating behaviors. Although most recommendations are extrapolated from studies involving patients with EDs (mainly binge eating disorder and bulimia nervosa), substance use disorders (SUDs), and MD (i.e., obesity), the proposed framework emphasizes mechanism-based assessment, individualized treatment formulation, and empirical testability. This perspective aims to provide a structured foundation for clinical decision-making while advancing a cautious research agenda to clarify the validity, boundaries, and therapeutic implications of UPFA.